From the Guidelines
While awaiting your Medtronic neurostimulator procedure, I strongly recommend a multimodal approach to manage chronic pain and mobility issues, prioritizing pharmacologic therapies and non-pharmacologic interventions as suggested by the American Academy of Neurology 1. To address your chronic pain, consider gabapentinoids, such as pregabalin, which has been supported by eight high-quality studies for the treatment of pain in diabetic neuropathy 1. Alternatively, serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine, supported by two high-quality studies, can be considered for pain management in diabetic neuropathy 1. For mobility issues, the use of adaptive devices, such as a back brace, can be beneficial for safety and function, especially if other methods are not available or if the patient's safety is a concern 1. Key components of this approach include:
- Pharmacologic therapies, such as gabapentinoids or SNRIs, to manage chronic pain
- Non-pharmacologic interventions, including physical therapy exercises focusing on gentle stretching, core strengthening, and range-of-motion activities
- Assistive devices, like canes or walkers, to prevent falls and reduce strain
- Heat or cold therapy to manage muscle pain or inflammation
- Mindfulness meditation or deep breathing exercises to help manage pain perception
- Proper sleep hygiene to establish a regular schedule and create a comfortable sleeping environment.
From the Research
Managing Chronic Pain and Mobility Issues
The user is experiencing chronic pain and mobility issues while awaiting a Medtronic implant procedure. To manage these issues, several options can be considered:
- The use of assistive technologies such as lumbar braces and devices to assist mobility and gait may be beneficial in improving pain and function in adults with chronic low back pain 2.
- However, a randomized controlled trial found that a back brace, when combined with education and exercise instruction, did not provide any pain relief compared with education and exercise instruction alone in patients with uncomplicated chronic low back pain 3.
- Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated effectiveness for improving function and work, and can be prescribed with three distinct goals: to improve or eliminate impairments in back flexibility and strength, to reduce the intensity of back pain, and to reduce back pain-related disability 4.
- Walking may be considered as an alternative to other physical activity, as it has been found to be similarly effective to exercise in improving pain, disability, quality of life, and fear-avoidance in chronic low back pain 5.
Medication Options
In addition to non-pharmacological interventions, medication options such as gabapentin may be considered for managing chronic neuropathic pain:
- Gabapentin has been found to provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy, with around 3 or 4 out of 10 participants achieving at least 50% pain intensity reduction 6.
- However, gabapentin may also be associated with adverse events such as dizziness, somnolence, peripheral oedema, and gait disturbance, and around half of those treated with gabapentin may not have worthwhile pain relief 6.
Considerations for the User
Based on the available evidence, the user may consider the following options to manage their chronic pain and mobility issues while awaiting the Medtronic implant procedure:
- Engaging in exercise or walking programs to improve function and reduce pain intensity
- Exploring alternative medication options such as gabapentin, under the guidance of a healthcare professional
- Discussing the potential benefits and limitations of using a back brace or other assistive technologies with a healthcare professional 2, 3